Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 38

38

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Table 3. Selection of Wound Care Dressing
Dressing Category
and Definition

Indications

Advantages

Disadvantages

Considerations, Usage,
and Precautions

PA S S IVE W OUND CARE PRODUCTS/ THERAPI ES

Alginates
Non-woven spun fibers
of brown seaweed used
as a non-occlusive
primary dressing.
They are shaped as
ropes or pads that
conform to the shape of
wound.
They have a fluffy
cottonlike appearance.

* Primary Dressing for
prophylaxis on highrisk intact skin
* Secondary dressing to
other products such as
foam, or alginates
* Superficial wounds
with minimal or no
exudate
* Eschar covered
wounds when
autolysis is indicated
often used as
secondary dressing to
alginates and foam

* Absorbent up to 20
times its weight
* Fills dead space
* Easy to use
* Supports debridement
in the presence of
exudate

* Requires a secondary
dressing
* Not recommended for
dry wounds or eschar
covered wound
* Not recommended for
deep undermined
ulcers in which wound
edges are at risk of
collapsing
* Can desiccate the
wound bed
* Not indicated for
patients with known
sensitivity to alginates
* Not recommended for
wounds in which the
dressing is not easily
retrievable as it may
break into pieces and
be a nidus of infection
if retained

* Not recommended in
non-draining wounds
* Loosely pack into a
wound
* May be layered into a
deep wound
* Requires a secondary
dressing to secure -
may use gauze or
transparent film as
secondary dressing

Transparent Film
Transparent
polyurethane sheets
coated on one side with
an acrylic hypoallergenic
adhesive film that is
impermeable to fluids
and bacteria.

* Primary Dressing for
prophylaxis on highrisk intact skin
* Secondary dressing to
other products such as
foam, or alginates
* Superficial wounds
with minimal or no
exudate
* Eschar covered
wounds when
autolysis is indicated
often used as
secondary dressing to
alginates and foam

* Visual evaluation of
wound without
removal
* Impermeable to
external fluids and
bacteria
* Transparent and
comfortable
* Promotes autolytic
debridement
* Minimizes friction

* Nonabsorbent
* Difficult to apply
* Channeling and
wrinkling occurs
* May dislodge in highfriction areas
* Not to be used on
wounds with
moderate to heavy
drainage because they
do not absorb
* Not to be used on
wounds with fragile
surrounding skin or
infected wound -
cause skin stripping

* Should not be used in
infected wounds that
require frequent
monitoring
* Allow 4-5 cm overlap
from wound margin
to the surrounding
skin.
* May leave undisturbed
up to 7 days.

Hydrocolloid
An occlusive or
semiocclusive dressing
composed of materials
such as gelatin, pectin,
and
carboxymethylcellulose.
They provide a moist
wound bed forming a
gelatinous mass over the
wound bed that allows
clean wounds to
granulate and necrotic
wounds to debride
autolytically. Available in
paste form that can be
used as filler for shallow
cavity wounds. Available
in variety of shapes,
widths, sizes, contours,
and thickness.

* Primary or secondary
dressing
* Partial- and fullthickness wounds
* Necrotic wounds or
wounds with slough
* Minimal - moderate
exudates
* May be used in
combination with
other dressing
materials (e.g., pastes,
alginates)

* Impermeable to
bacteria and other
contaminants
* Waterproof
* Easy to apply and
time-saving
* Thin forms diminish
friction and minimizes
"rolling" or "curling
up"
* Conformable, selfadherent, and
absorptive
* Facilitates autolytic
debridement
* May be used in
combination with
compression for
venous ulcers

* Not recommended for
use in wounds with
heavy exudate, depth
or friable periwound
skin, wounds with
exposed tendon or
bone
* Its occlusive property
limits gas exchange
between the wound
and the environment
* May curl at the edges
and could injure
fragile skin upon
removal
* May contribute to
hypergranulation
tissue

* Select a dressing with
a minimum of 2-3 cm
overlap from the
margin of the wound
* May be cut to conform
to difficult areas
* Change dressings up
to 3 times a week
Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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